Provider Demographics
NPI:1023213154
Name:EMANUELLI ANZALOTTA, ANDRES (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDRES
Middle Name:
Last Name:EMANUELLI ANZALOTTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2770
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-2770
Mailing Address - Country:US
Mailing Address - Phone:787-449-5859
Mailing Address - Fax:
Practice Address - Street 1:452 AVE RIVERA AULET
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-4368
Practice Address - Country:US
Practice Address - Phone:787-680-7222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16978207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR16978OtherLICENCIA MD